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ACORDCERTIFICATE OF LIABILITY INSURANCE DATE411912 riri) le. ' 4/1 912 010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Rnitnn A I._- T INSURED CWF, Inc. DBA: Al Paty Rentals 251 E. Front Street Covina CA 91723 COVFRAf;FB Suite 100 0008309 CFGTICICA TF MIIMRFR• onclnv 799.7000 FAX ..,. ovvlmnu unemce. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, NSR. LTRI ADDL RUBR'"-�POLIdYEFPTP''-� TYPEOFINSURANCE 0' POLICY KUMREft Ih1M12fYYY MMIDDIYYW - LIMITS --- B COMMERCIAL GENERAL LIABILITY ✓ PK201600007271 2/1/2018 2/1/2017 ' EACH OCCURRENCE $ 1,_000,000_ �� J CLAIMS � �`C I)_ _ MADE :Z OCCUR PREMISES jE�occyrrence 5 506,000 MED E%P (Any one person) I,$ 10,000 _ I GENL AGGREGATE LIMIT APPLIES PERIGENERAL AGGREGATE �$ 2,000,000 F' POLICY ✓ PEO ✓ WC PRODUCTS - COMPIOP AGO •; $ 2.006000 OTHER', A I AUTOMOBILELIABILITY 1CPP006511201 2/1/2016 112/1/2017 — iMBNDIN LE LIMIT 1000000 •� ANY AUTO BODILY INJURY (Per person) $ _ r� ONINED1— SCHEDULED AUTOS ONLY 1 "— ... 3 BODILY INJURY (Per accNeHIRED _....._.... .... 1�71 NONOWNED NON r.✓.. ✓' PROPERTY DAMAGE AUTOS ONLY ;AUTOS ONLY - (per acrdtlenll s._—. 8 , umsaeLLa Llan ./ occuRIUM201600003772 12/1/2016 i 12/1/2017 EACH OCCURRENCE $ 5,000 000 E ,$ I V .5,000,000 OLDI RETENrION100,000'AGGREGATE 13 B WORKERSCOMPENSATION IWC2015000009970 111/1/2015 11/1/2016 ✓ STATUTE-_„-,•°RH AND EMPLOYERS' LIABILITYYIN ANYPROPRIETORIPAFTNERIEXECUTIVE - Y NIAj - OFFICE(Mandatory EL EACH ACCIDENT $ 1,000,060 In NH�EXCLUOEDp E.L. DISEAS $ 1600660 �,—,-- If pee, describe under DESCRIPTION OFOPERATIONS below - --- E.L. DISEASE -POLICY LIMIT '$ 11006000 DESORIPTIONOFOPERATIONSILCCATIONSIVEHICLEa IAaoRD 1ET,Atltlltlonal Remarks 9cryetluln, pl9y ba attached lPmore space is roquired) „��/ The certificate holder is included as an additional Insured, but only as respects to claims arising out of the negligence of h�Q1'dmed Insured, GL Primary & Non -Contributory form CC2026 attached. r� Qi per Additional Insured: The City GF Santa Ana, It's officers, employees, agents, and representatives A City of Santa Ana Finance & Managgement Services Agency PC Box 1988 M-16 20 Civic Center Plaza Santa Ana CA 92702 SHOULD ANY OK THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Jessica Persia © 1988-2015 ACORD CORPORATION, All riahts reserved. ACORD 26 (2016(03) The ACORD name and logo are registered marks of ACORD 29519x16 1 CWVTNL'A-01 1 15-1a Ira Le -Ir, aL.er0,i agxp Meana¢ CexeSfivace I Allea Lopez 1 4/19/2010 3,51:44 PM ;Pi I Page I of 2